Purpose

We update the incidence of intraocular foreign bodies (IOFB) in soldiers admitted to Walter Reed Army Medical Center from 2001 to 2011 after sustaining combat injuries in Operation Iraqi Freedom and Operation Enduring Freedom.

Design

This consecutive retrospective case series included 890 eyes of 652 patients.

Methods

Data were collected in the Walter Reed Ocular Trauma Database. Inclusion criteria were any American soldier or Department of Defense civilian with an IOFB injured in Operation Iraqi Freedom/Operation Enduring Freedom. Closed globe injuries with orbital foreign bodies, injury outside of a combat zone, or non–Department of Defense civilian trauma were the exclusion criteria.

Main Outcome Measures

Primary outcome measures were final visual outcome and the number, size, and location of IOFBs. Secondary outcome measures included surgical procedures, use of eye protection, associated complications, source of injury and Ocular Trauma Score.

Results

There were 890 eye injuries in 652 patients evacuated to Walter Reed Army Medical Center between 2001 and 2011. IOFBs were found in 166 eyes of 149 patients (18.6%; 95% confidence interval [CI], 16.2%–21.3%). Most patients had a single IOFB (80.7%). An IOFB was positively associated with Ocular Trauma Score grade 1 or 2 (0–65) injuries (odds ratio [OR], 1.58; 95% CI, 1.07–2.38; P = 0.01). There were 130 eyes (78.33%) that had recorded time from initial visual acuity to final visual acuity and it ranged from 8 to 2421 days (mean, 433.24 days). Thirty-eight (25.16%; 95% CI, 18.89%–32.67%) eyes had no change in visual acuity, 98 (64.90%; 95% CI, 57.00%–72.07%) had improved visual acuity, and 15 (9.93%; 95% CI, 6.01%–15.84%) had decreased visual acuity. IOFB was not found to predict final visual acuity of <20/200 in multivariate analysis when other injury features were known (P = 0.1). Pars plana vitrectomy was completed on 124 eyes (74.70%). Removal of IOFB was performed in 118 eyes (71.08%; average of 31.67 days after initial injury) with a delayed procedure occurring after primary closure and antibiotics owing to a lack of surgical capacity in Iraq and Afghanistan. Retinal detachment occurred in 48 eyes (28.92%) and proliferative vitreoretinopathy in 44 eyes (26.5%).

Conclusions

IOFBs occur frequently in combat ocular trauma and are significantly associated with more severe injuries. However, IOFBs were not found to be a significant risk factor for visual acuity of <20/200.

中文翻译：

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伊拉克自由行动和持久自由行动中的眼内异物创伤

目的

我们更新了2001年至2011年在“伊拉克自由行动”和“持久自由行动”中遭受战斗伤害后入伍的沃尔特·里德陆军医疗中心入伍士兵的眼内异物（IOFB）的发生率。

设计

连续的回顾性病例系列包括652例患者的890眼。

方法

在沃尔特·里德眼外伤数据库中收集数据。入选标准是在“伊拉克自由/持久自由行动”中遭受IOFB伤害的任何美国士兵或国防部文职人员。排除标准包括眼球异物引起的闭合性地球伤害，战斗区域以外的伤害或非国防部的平民伤害。

主要观察指标

主要结局指标是最终的视觉结局以及IOFB的数量，大小和位置。次要结局指标包括手术程序，使用眼罩，相关并发症，损伤源和眼外伤评分。

结果

在2001年至2011年之间，有652例患者被疏散到Walter Reed军队医疗中心，共造成890例眼外伤。在149例患者的166眼中发现了IOFB（18.6％； 95％置信区间[CI]，16.2％–21.3％）。大多数患者只有一个IOFB（80.7％）。IOFB与1或2级眼外伤评分（0-65）损伤呈正相关（赔率[OR]为1.58； 95％CI为1.07-2.38；P = 0.01）。有130只眼（78.33％）被记录下从最初的视敏度到最终的视敏度，时间范围为8到2421天（平均433.24天）。38眼（25.16％; 95％CI，18.89％–32.67％）的视力没有变化，98眼（64.90％; 95％CI，57.00％–72.07％）的视力有所改善，15眼（9.93％） ； 95％CI，6.01％–15.84％）视力下降。当已知其他损伤特征时，在多变量分析中未发现IOFB可以预测最终视力<20/200（P = 0.1）。124眼（74.70％）完成了帕氏玻璃体玻璃体切除术。由于伊拉克和阿富汗缺乏手术能力，在118眼（71.08％；平均受伤后平均31.67天）中进行了IOFB的切除，但在初次封堵和使用抗生素后出现了延迟手术。视网膜脱离发生在48只眼中（28.92％），而增殖性玻璃体视网膜病变发生在44只眼中（26.5％）。

结论

IOFB在眼外伤的战斗中经常发生，并且与更严重的伤害显着相关。但是，未发现IOFB是<20/200视敏度的重要危险因素。